Radiotherapy for Prostate Cancer Patients with Pelvic Lymph Node Metastasis

  • Seung Gyu Park
  • Won Park


The prostate cancer (PCA) disseminates by the lymphatics, the perineural spaces, and the venous routes through the Santorini’s venous plexus. The lymphatic dissemination includes external iliac nodes, hypogastric nodes, and lateral and subaortic sacral nodes [1].


  1. 1.
    Porcaro AB, De Luyk N, Corsi P, Sebben M, Tafuri A, Processali T, et al. Clinical factors predicting bilateral lymph node invasion in high-risk prostate cancer. Urol Int. 2017;99(4):392–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Fast Stats: an interactive tool for access to SEER cancer statistics.
  3. 3.
    Jeong IG, Dajani D, Verghese M, Hwang J, Cho YM, Hong JH, et al. Differences in the aggressiveness of prostate cancer among Korean, Caucasian, and African American men: A retrospective cohort study of radical prostatectomy. Urol Oncol. 2016;34(1):3 e9–14.CrossRefGoogle Scholar
  4. 4.
    James L, Mohler M, Armstrong AJ, Bahnson RR, D’Amico AV, Davis BJ. Prostate cancer, version 1.2016. J Natl Compr Cancer Netw. 2016;14(1):19–30.CrossRefGoogle Scholar
  5. 5.
    Hovels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008;63(4):387–95.CrossRefPubMedGoogle Scholar
  6. 6.
    Heck MM, Souvatzoglou M, Retz M, Nawroth R, Kubler H, Maurer T, et al. Prospective comparison of computed tomography, diffusion-weighted magnetic resonance imaging and [11C]choline positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer patients. Eur J Nucl Med Mol Imaging. 2014;41(4):694–701.CrossRefPubMedGoogle Scholar
  7. 7.
    Cimino S, Reale G, Castelli T, Favilla V, Giardina R, Russo GI, et al. Comparison between Briganti, Partin and MSKCC tools in predicting positive lymph nodes in prostate cancer: a systematic review and meta-analysis. Scand J Urol. 2017;51(5):345–50.CrossRefPubMedGoogle Scholar
  8. 8.
    Makarov DV, Trock BJ, Humphreys EB, Mangold LA, Walsh PC, Epstein JI, et al. Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, and biopsy Gleason score (Partin tables) based on cases from 2000 to 2005. Urology. 2007;69(6):1095–101.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Cagiannos I, Karakiewicz P, Eastham JA, Ohori M, Rabbani F, Gerigk C, et al. A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. J Urol. 2003;170(5):1798–803.CrossRefPubMedGoogle Scholar
  10. 10.
    Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol. 2012;61(3):480–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Baker BR, Mohiuddin JJ, Chen RC. The role of radiotherapy in node-positive prostate cancer. Oncology. 2015;29(2):108–14, 16.PubMedGoogle Scholar
  12. 12.
    Schroder FH, Kurth KH, Fossa SD, Hoekstra W, Karthaus PP, Debois M, et al. Early versus delayed endocrine treatment of pN1-3 M0 prostate cancer without local treatment of the primary tumor: results of European Organisation for the Research and Treatment of Cancer 30846--a phase III study. J Urol. 2004;172(3):923–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Schroder FH, Kurth KH, Fossa SD, Hoekstra W, Karthaus PP, De Prijck L, et al. Early versus delayed endocrine treatment of T2-T3 pN1-3 M0 prostate cancer without local treatment of the primary tumour: final results of European Organisation for the Research and Treatment of Cancer protocol 30846 after 13 years of follow-up (a randomised controlled trial). Eur Urol. 2009;55(1):14–22.CrossRefPubMedGoogle Scholar
  14. 14.
    Mason MD, Parulekar WR, Sydes MR, Brundage M, Kirkbride P, Gospodarowicz M, et al. Final report of the intergroup randomized study of combined androgen-deprivation therapy plus radiotherapy versus androgen-deprivation therapy alone in locally advanced prostate cancer. J Clin Oncol. 2015;33(19):2143–50.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Warde P, Mason M, Ding K, Kirkbride P, Brundage M, Cowan R, et al. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. Lancet. 2011;378(9809):2104–11.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Widmark A, Klepp O, Solberg A, Damber J-E, Angelsen A, Fransson P, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009;373(9660):301–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Zagars GK, Pollack A, von Eschenbach AC. Addition of radiation therapy to androgen ablation improves outcome for subclinically node-positive prostate cancer. Urology. 2001;58(2):233–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Rusthoven CG, Carlson JA, Waxweiler TV, Raben D, Dewitt PE, Crawford ED, et al. The impact of definitive local therapy for lymph node-positive prostate cancer: a population-based study. Int J Radiat Oncol Biol Phys. 2014;88(5):1064–73.CrossRefPubMedGoogle Scholar
  19. 19.
    Tward JD, Kokeny KE, Shrieve DC. Radiation therapy for clinically node-positive prostate adenocarcinoma is correlated with improved overall and prostate cancer-specific survival. Pract Radiat Oncol. 2013;3(3):234–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Lin CC, Gray PJ, Jemal A, Efstathiou JA. Androgen deprivation with or without radiation therapy for clinically node-positive prostate cancer. J Natl Cancer Inst. 2015;107(7).Google Scholar
  21. 21.
    James ND, Spears MR, Clarke NW, Dearnaley DP, Mason MD, Parker CC, et al. Failure-free survival and radiotherapy in patients with newly diagnosed nonmetastatic prostate cancer: data from patients in the control arm of the STAMPEDE trial. JAMA Oncol. 2016;2(3):348–57.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Denham JW, Steigler A, Lamb DS, Joseph D, Mameghan H, Turner S, et al. Short-term androgen deprivation and radiotherapy for locally advanced prostate cancer: results from the Trans-Tasman Radiation Oncology Group 96.01 randomised controlled trial. Lancet Oncol. 2005;6(11):841–50.CrossRefPubMedGoogle Scholar
  23. 23.
    Bolla M, Collette L, Blank L, Warde P, Dubois JB, Mirimanoff R-O, et al. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet. 2002;360(9327):103–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Roach M 3rd, Bae K, Speight J, Wolkov HB, Rubin P, Lee RJ, et al. Short-term neoadjuvant androgen deprivation therapy and external-beam radiotherapy for locally advanced prostate cancer: long-term results of RTOG 8610. J Clin Oncol. 2008;26(4):585–91.CrossRefPubMedGoogle Scholar
  25. 25.
    Pilepich MV, Winter K, Lawton CA, Krisch RE, Wolkov HB, Movsas B, et al. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma--long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys. 2005;61(5):1285–90.CrossRefPubMedGoogle Scholar
  26. 26.
    Lawton CA, Winter K, Grignon D, Pilepich MV. Androgen suppression plus radiation versus radiation alone for patients with stage D1/pathologic node-positive adenocarcinoma of the prostate: updated results based on national prospective randomized trial Radiation Therapy Oncology Group 85-31. J Clin Oncol. 2005;23(4):800–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Granfors T, Modig H, Damber JE, Tomic R. Long-term followup of a randomized study of locally advanced prostate cancer treated with combined orchiectomy and external radiotherapy versus radiotherapy alone. J Urol. 2006;176(2):544–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G, et al. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol. 2006;7(6):472–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA. 2006;296(19):2329–35.CrossRefPubMedGoogle Scholar
  30. 30.
    Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol. 2009;181(3):956–62.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Storkel S, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol. 2009;27(18):2924–30.CrossRefPubMedGoogle Scholar
  32. 32.
    Briganti A, Karnes RJ, Da Pozzo LF, Cozzarini C, Capitanio U, Gallina A, et al. Combination of adjuvant hormonal and radiation therapy significantly prolongs survival of patients with pT2-4 pN+ prostate cancer: results of a matched analysis. Eur Urol. 2011;59(5):832–40.CrossRefPubMedGoogle Scholar
  33. 33.
    Abdollah F, Karnes RJ, Suardi N, Cozzarini C, Gandaglia G, Fossati N, et al. Impact of adjuvant radiotherapy on survival of patients with node-positive prostate cancer. J Clin Oncol. 2014;32(35):3939–47.CrossRefPubMedGoogle Scholar
  34. 34.
    Jegadeesh N, Liu Y, Zhang C, Zhong J, Cassidy RJ, Gillespie T, et al. The role of adjuvant radiotherapy in pathologically lymph node-positive prostate cancer. Cancer. 2017;123(3):512–20.CrossRefPubMedGoogle Scholar
  35. 35.
    Kaplan JR, Kowalczyk KJ, Borza T, Gu X, Lipsitz SR, Nguyen PL, et al. Patterns of care and outcomes of radiotherapy for lymph node positivity after radical prostatectomy. BJU Int. 2013;111(8):1208–14.CrossRefPubMedGoogle Scholar
  36. 36.
    Rusthoven CG, Carlson JA, Kavanagh BD. External validation of the benefit of adjuvant radiotherapy for pathologic N1M0 prostate cancer. J Clin Oncol. 2015;33(17):1987–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea

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